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LUMEN Course Features Transradial STEMI: Treating a Heart Attack from the Wrist

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10th Annual LUMEN Course

The LUMEN Course
in Miami, Florida

February 13, 2011 -- The most dangerous type of heart attack is an ST segment Elevated Myocardial Infarction, or STEMI. An angioplasty procedure can open up the blocked coronary artery that is causing the heart attack quickly. In fact, cardiac centers have been striving for door-to-balloon times of less than 90 minutes.

In less than two hours from arriving at such a hospital, a patient can have his heart attack stopped in its tracks: damage to the heart muscle is minimized; the recovery time is shortened; and, a future of diminished health is no longer a sealed fate.

The treatment of STEMI is the subject of a two-and-a-half-day course being held in Miami, Florida on February 24-26, 2011. As Course Director, Dr. Sameer Mehta, explains:

Dr. Sameer Mehta
    "The annual LUMEN symposium, now in its 10th year, is constantly evolving to provide attendees with the latest information on best clinical practices, processes and procedures in achieving optimal outcomes for the STEMI patient. Led by world experts, this exciting two-and-a-half day program is a one-stop STEMI educational rendezvous for clinical and interventional cardiologists, cardiac and vascular surgeons, ED staff, critical care nurses, cardiovascular laboratory technologists and nurses, paramedics, and hospital administrators."

New this year is an emphasis on utilizing the transradial angioplasty approach for STEMI, where access is performed through the radial artery in the wrist instead of the femoral artery in the groin. One reason that transradial may be useful is that the femoral access site is more prone to bleeding complications and in STEMI patients, who often are given a significant amount of anticoagulant and antiplatelet drugs to lessen the blood clot causing the heart attack, bleeding can become a problem. And the transradial approach virtually eliminates bleeding complications.

Yet, because the femoral approach is the default access site in the United States, transradial is performed in only 5% of cases, although in many European and Asian centers, the wrist is used more than half the time. The problem, discussed in many articles on Angioplasty.Org, is one of training. Few U.S. cardiologists know how to do radial procedures. Although the wrist approach may not be suitable for all patients, Dr. Mehta told Angioplasty.Org, in his exclusive interview, that the cardiology practice in the U.S. is:

"...grossly underpenetrated in our application of transradial STEMI intervention. I think there’s too much resistance, too much lack of awareness and comfort level among interventional cardiologists to try the transradial approach.... Transradial is not going to be for every case, but I think the penetration should increase. The physicians that are performing STEMI interventions should feel comfortable with both techniques.

"We understand that there is a direct correlation between bleeding during the STEMI...and long-term mortality. So this is not a small matter to be dismissed as a nuisance or something. Not only do the patients do poorly early on, but there is even an impact on their long-term mortality. So it's something extremely critical and I think the control of bleeding is vital."

Dr. Mehta suggests that one strategy for lowering the bleeding complications even further is doing transradial and using the anticoagulant bivalirudin (Angiomax®):

"I'm convinced that the absolutely perfect combination for a lot of these patients is going to be transradial procedures performed with bivalirudin. You have the access site which reduces bleeding, as well as a drug which is known to reduce bleeding on the basis of the data from the HORIZONS AMI trial. The combination probably represents the most optimal way of performing a STEMI intervention."

The LUMEN course is being held at the JW Marriott Marquis Miami, Thursday, February 24 through Saturday, February 26, 2011. On Friday morning, February 25, a two hour symposium on "Transradial STEMI Interventions" will be chaired by Dr. Sunil Rao and Dr. Mitch Krucoff. In the afternoon, Dr.Tejas Patel from Ahmadabad, India, who has perhaps the world’s most extensive experience in transradial STEMI interventions, will lead a workshop on this technically challenging procedure. More information can be found on the LUMEN web site,, including online registration and an attendee brochure (PDF).

About The Radial Access Center on Angioplasty.Org
To assist in educating the professional and patient population in the U.S. about the this technique, Angioplasty.Org created the "Radial Access Center for Transradial Approach" in 2007, a special section devoted to information and news about the transradial technique, for both patients and physicians. The Radial Center features interviews with leading practitioners of the radial technique, such as Drs. Jeffrey Popma, Sunil Rao, Mauricio Cohen, John Coppola, Shigeru Saito and Jennifer Tremmel. The section also maintains a listing of upcoming training courses in the transradial approach.

For patients there is also a "Hospital Locator" that lists U.S. centers practicing radial angiography. As Dr. Howard Cohen of Lenox Hill Hospital in New York says of the wrist technique, "Patients really prefer it. 95% of people who've had it both ways would say 'I'm coming back to you, Dr. Cohen because I like this transradial a lot better than the other way!'

Reported by Burt Cohen, February 13, 2011